Device-related thrombosis (DRT) is one of the major postoperative complications following the implantation of a left atrial appendage occluder. Selecting the most effective antithrombotic strategy to prevent DRT in patients after LAAO has been a hot topic of interest. Recently, a study by Professor Jules Mesnier and others published in JACC indicated that early non-surgical bleeding after LAAO is associated with increased mortality, and dual antiplatelet therapy (DAPT) is related to an increased risk of early non-surgical bleeding following LAAO.
Research Background
Patients undergoing left atrial appendage occlusion (LAAO) have a high risk of bleeding, and enhanced antithrombotic therapy is recommended postoperatively to prevent device-related thrombosis.
Research Objective
This study aims to assess the incidence, consequences, and predictors of early non-surgical bleeding related to LAAO.
Research Methods
This study is a multicenter research involving 1,649 patients from 9 centers who underwent LAAO treatment. Early non-surgical bleeding is defined as bleeding unrelated to the surgery occurring within 3 months after the implantation of the left atrial appendage occluder, with severity classified according to VARC-2 definitions. Sensitivity analysis was conducted at 45 days.Research ResultsA total of 121 patients (7.3%) experienced early non-surgical bleeding events, of which 69 cases (57.0%) were classified as major bleeding (4.2% of the total patient population) (Figure 1).
Figure 1. Early Non-Surgical Bleeding Related to Procedures
Independent predictors of early non-surgical bleeding include DAPT at discharge (adjusted HR [aHR]: 1.61; 95% CI: 1.12-2.33; P = 0.01), history of gastrointestinal bleeding (aHR: 2.15; 95% CI: 1.38-3.35; P < 0.001), and history of bleeding at multiple sites (aHR: 2.33; 95% CI: 1.34-4.05; P < 0.001) (Table 1). DAPT at discharge predicted all non-surgical bleeding and major non-surgical bleeding at 3 months and 45 days follow-up. After a median follow-up of 2.3 years (Q1-Q3: 1.1-4.1 years), early non-surgical bleeding was independently associated with an increased risk of all-cause mortality (aHR: 1.53; 95% CI: 1.15-2.06; P < 0.001), similar to the increased risk of mortality at 45 days.
Table 1. Independent Predictors of Early Non-Surgical Bleeding
ConclusionWithin 3 months post-LAAO, approximately 7% of patients experienced early non-surgical bleeding, with over half (4%) classified as major bleeding. Regardless of severity, early non-surgical bleeding is associated with increased mortality, and DAPT at discharge leads to an elevated risk of early non-surgical bleeding after LAAO. This result emphasizes the importance of determining antithrombotic strategies post-LAAO based on the patient’s bleeding risk.
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